17A-208 (3) y PERMIT APPLICATION CHECK LIST
PAGE I l PLOT --2-C,)e ZONE 12-< Y)� yn4r&l YES NO DATE
1 , ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 . -OWNER OCCUPANT E IC . NO
4 . 3 SETS OF S /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 , ADDITION
10 , ACCESSORY STRUCTURE
11 . SIGN AWNING
12 , PERMIT FEE - CHECK ONLY - MONEY OgnERVJ
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM A
16 , FILL
COMMENTS -
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COMMON EAL r H AI'\TBnZr;T OF PUBLIC SAFETY _
OF 1G COMM04WEALTH AVE.
MASSACHUSETTS OSTON,MASS.02215 ENCLOSE CHECK OR MONEY ORDEF
EXPIRATION DATE
L I �=Si FOR REQUIRED FEE,
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� T ;. LP ?\f] S MADE PAYABLE TO
RESTRICTIONS EFFECTIVE DATE LIC-NO.
ta0t "COMMISSIONER OF PUBLIC SAFETY"
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(DO NOT SEND CASH).
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HEIGHT: NC?'\'/LID JNTIL SIGNED BY LICENSEE AND OFFICIALLY y "
STAMPED-OR SIGNATURE OF THE COMMISSIONER
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j,CT D£TA�H L I TEN E STUF,TDOCUMENT MOST , ;NA'URE OF LICENStt SIGN NAME IN FULL-ABOVE SIGNATURE LINE
CARRIED ON THE PE FSON EDE HOLDER N'OCC Tl Y .IYIC (.'
COMMISSIONER
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No S- 0 1 O Alterations
NORTHAMPTON, MASS. 19 Additions
go APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �. tJ �CC1a \ S o c� C—$ Lot No.
2. Owner's name a �� Address
3. Builder's name >!` Co Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch °
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage '.-�i No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cos4, 0
I
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible appicant
Remarks
Date Filed File No.
ZONING PERMIT APPLICATION (§10. 2)
1. Name of Applicant:
Address: Q Telephone:
2 . Owner of Property: .,h4
Address : elephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#J Parcel#-20,� r
Zoning District (s) (include over ays) CC
Street Address Z cat -
Required
5 . Existing Proposed -by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary
� lLte rn
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: S' 3 Applicant's Signature:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
yApproved as presented/based on information presented
Denied as presented--Reason:
K S ecial rmit and/or Site Plan Required:
in red: Variance Required:
1�
igna re of Bui nspector �� ' Date
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
ie,71-
A �
City of'Northampton REQUIRED INSPECTIONS
e BUILDING DEPARTMENT 1. Footings and Walls
2. Structural Components in Place*
3. Complete Building*
No. 172 Office of the Building Inspector
Zoning Form No. 000855 Date 4/7/93 Fee $20
Check#M0#15-703140
Page,
17A Parcel 208 ,Zone U RB Section 127 ❑ Yes ❑ No
BUIULDING PEIRMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Wallace Brown before Building Inspections
has permission to Install GAF r u b e r o i d torch down (rubber roof)Inspection on S ite—Foundations
situated on 125 North Maple street Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office,and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPIC S P ON THE PREMISES
Certificate of Occupancy
ng Inspector �°P